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Congress: Advance Prior Authorization Reforms

Beginning in May, ASPS has been involved in shaping the H.R.3107, the Improving Seniors' Timely Access to Care Act, which would improve prior authorization requirements within the Medicare Advantage (MA) program. In collaborating with other groups, namely the Alliance of Specialty Medicine, ASPS joined a strong stakeholder group that is advocating for important changes that would alleviate administrative burdens in one of the fastest-growing parts of Medicare. Specifically, the bill would: create an electronic prior authorization program; increase transparency by mandating plans to report to CMS on the extent of their prior authorization use; require MA plans to implement annually-reviewed, transparent prior authorization programs; require plans to provide rationales for denials; and eliminate redundant prior authorization requirements.

The bill language was finalized at the end of May and introduced formally on June 5. In September, the medical community sent a large sign-on letter with over 350 signatories to all members of the House of Representatives. Following that outreach, over 60 cosponsors have been added to the bill. Subsequently, ASPS reached out to the sponsors – Reps. Suzan DelBene [D-WA-1], Mike Kelly [R-PA-16], Roger Marshall [R-KS-1] and Ami Bera [D-CA-7] – with its own letter October 8, reiterating the Society's willingness to support the proposal. The legislation has 96 bipartisan cosponsors, with even support from both parties, and awaits further consideration by the House Ways and Means Committee and House Energy and Commerce Committee.

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